University of Nebraska



University of Nebraska

Main Form (Teachers fill this one out)

WAIVER AND RELEASE OF LIABILITY for

University-sponsored Events / Activities

DISCLAIMER: The UNIVERSITY OF NEBRASKA is NOT RESPONSIBLE for any injury or loss of property to any person suffered while traveling to, preparing for, or participating in The SPIRIT Institute Events / Activities for any reason whatsoever, including ordinary negligence.

This WAIVER and RELEASE OF LIABILITY was executed this 7th day of July 2008, for the State of Nebraska by _____________________, (Releasor) in favor of the UNIVERSITY OF NEBRASKA and its Regents, Officers, Employees, Instructors, Staff, agents, operators, successors, and assigns (University).

The Releasor wishes to participate in University-sponsored SPIRIT events / educational robotics workshop activities. In consideration for the privilege of participation in the program, the Releasor consents and agrees to the following:

1. Releasor certifies that he/she is physically capable of participating in University Outreach Activities and that he/she will take responsibility for physical capability to perform under normal conditions of SPIRIT activities, to include soldering and small electronic parts assembly. Releasor is encouraged to get his/her physician’s opinion prior to participating in any SPIRIT activity. In the event of a medical emergency, the University of Nebraska or its representatives have my permission to take whatever measures they deem reasonable to render assistance and that I and/or my family will be financially responsible for any expenses involved.

2. Releasor realizes that participation in University-Sponsored outreach activities involves certain risks and danger. Releasor has hereby been made aware that participation in University-Sponsored outreach activities has the following generalized and non-exclusive list of certain risks which I accept: death; head, eye, neck, and spinal injury resulting in complete or partial paralysis; brain damage; heart attack; blisters; cuts; lacerations; abrasions; concussions; contusions; strains; sprains; dislocations; fractures; cold and heat injuries; water immersion; drowning; lightning strikes; injury to bones, joints, muscles, internal organs; and environmental conditions. In addition, I understand and accept the incidental risks of travel to and from the site of activity; participation at sites that may be remote from available medical assistance; and the possible reckless conduct of other participants.

3. Consequently, while understanding that the University has taken precautions to provide organization, supervision, and equipment for reasonable safety, Releasor assumes joint and personal responsibility for safety while participating in University outreach activities. Pursuant to that joint and personal responsibility, Releasor agrees to comply with the instructions and direction of representatives and staff members of the University-sponsored outreach event. Releasor understands that failure to abide by the instructions and rules may result in his/her termination from the activity. Releasor accepts personal responsibility to ensure that any equipment needed to participate in the University Outdoor Recreational Activity and used by the Releasor is safe and functioning properly and to refrain from causing loss or damage to the property of the University and / or the activity site. Releasor realizes that he/she is jointly responsible for any personal equipment, supplies, or property he/she may choose to use during the duration of the activity.

4. Releasor further agrees to indemnify and hold harmless the University for any and all claims or actions as a result of engaging in, using University-Sponsored facilities and equipment, or receiving instruction for University outreach activities or any activities incidental thereto whatsoever, whenever, or however the same may occur.

5. Releasor acknowledges that photographs and digital images may be taken during participation. Releasor understands and agrees that the images may be published and used by the University.

6. Releasor is aware that if he/she uses a vehicle not operated by the University for transportation to, at, or leaving the activity site, the University is NOT responsible for any damage caused by or arising from Releasor’s use of such vehicle. Furthermore, Releasor acknowledges that he/she is solely responsible for any action he/she takes outside the scope of those actions permitted by the University for purposes of the particular activity regardless if occurring before, during, or after the duration of the activity.

7. In consideration of participation in University-Sponsored Outreach Activities, Releasor hereby RELEASES and covenants not-to-sue the UNIVERSITY for any and all present and future claims resulting from ordinary negligence on the part of the UNIVERSITY for property damage, personal injury, or wrongful death arising as a result of my engaging in, using University facilities and equipment, or receiving instruction for University-sponsored outreach activities or activities thereto, wherever, whenever, or however the same may occur. Releasor hereby voluntarily waives any and all claims or actions resulting from ordinary negligence, both present and future, that may be made by Releasor’s family, estate, personal representative, heirs, or assigns.

I have read and understand that this WAIVER is intended to be as broad and inclusive as permitted by the laws of the State of Nebraska and agree that if any part is held invalid, the remaining parts of this WAIVER AND RELEASE will continue in full force and effect as intended. I further agree the venue for any legal proceeding shall be in the State of Nebraska.

I understand the rights that I am waiving and that I am freely signing this WAIVER AND RELEASE. I have read and fully understand that by signing this agreement I am giving up legal rights and remedies, which may be available to me for ordinary negligence of the University. I further agree to follow and abide by the regulations and rules of the UNIVERSITY as they pertain to University-Sponsored outreach activities and to reimburse and make good to the UNIVERSITY any loss, damage, or cost the UNIVERSITY may have to pay as a result of my participation in the program.

______________ ______________ ____

RELEASOR (Signed) RELEASOR (Printed) Date

The following is for informational purposes only:

________________ _____________ _________________________

Emergency Contact Contact Phone # Contact Address, City & State

Releasor’s Gender: M F

Releasor’s Age: 19 years of age or older (circle) Yes No

University of Nebraska

Guardian Form (Under 19 fill this one out)

WAIVER AND RELEASE OF LIABILITY for University-sponsored SPIRIT Educational Robotics Events / Activities

DISCLAIMER: The UNIVERSITY OF NEBRASKA is NOT RESPONSIBLE for any injury or loss of property to any person suffered while participating in University-sponsored SPIRIT Events / Activities for any reason whatsoever, including ordinary negligence.

This WAIVER and RELEASE OF LIABILITY was executed this ____ day of ___________ 2____, for the State of Nebraska by _____________________, (Releasor) in favor of the UNIVERSITY OF NEBRASKA and its Regents, Officers, Employees, Instructors, Staff, agents, operators, successors, and assigns (University).

In consideration for the Minor’s participation in University-Sponsored SPIRIT Events / Activities, Releasor hereby RELEASES and covenants not-to-sue the UNIVERSITY for any and all present and future claims resulting from ordinary negligence on the part of the UNIVERSITY for property damage, personal injury, or wrongful death arising as a result of engaging in, using University facilities and equipment, or receiving instruction for University SPIRIT Activities or activities thereto, wherever, whenever, or however the same may occur. Releasor hereby voluntarily waives any and all claims or actions resulting from ordinary negligence, both present and future, that may be made by Releasor’s family, estate, personal representative, heirs, or assigns.

Releasor realizes that participation in a University-sponsored Recreational Outdoor Activity involves certain risks and danger. Releasor has hereby been made aware that participation in University-sponsored SPIRIT Activities has the following non-exclusive list of certain risks which I accept: death; head, eye, neck, and spinal injury resulting in complete or partial paralysis; brain damage; heart attack; blisters; cuts; lacerations; abrasions; concussions; contusions; strains; sprains; dislocations; fractures; cold and heat injuries; water immersion; drowning; lightning strikes; injury to bones, joints, muscles, internal organs; and environmental conditions. In addition, I understand and accept the incidental risks of engineering related activities, soldering, travel to and from the site of activity; participation at sites that may be remote from available medical assistance; and the possible reckless conduct of other participants.

In the event of a medical emergency, the University of Nebraska or its representatives have my permission to take whatever measures they deem reasonable to render assistance and that I and/or my family will be financially responsible for any expense involved.

I have read and understand that this WAIVER is intended to be as broad and inclusive as permitted by the laws of the State of Nebraska and agree that if any part is held invalid, the remaining parts of this WAIVER AND RELEASE will continue in full force and effect as intended. I further agree that the venue for any legal proceeding shall be in the State of Nebraska.

____________________________ ____________________________

GUARDIAN (Signed) (Printed) Date

____________________________ ____________________________

Minor’s Name Minor’s Date of Birth

Medical-Insurance Information and Consent

As Guardian of ______________________, he/she is physically capable of participating in all University-Sponsored SPIRIT Events / Activities

under normal, reasonable conditions and medical/health insurance coverage for the minor child is the Guardian’s responsibility.

Medical Insurance Co:____________________

Policy# __________________________

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